Note to actor: Try to restrain yourself from volunteering to much information – you may do so when prompted (that is, by a specific question, not a general one). If a student is on the wrong line of clinical reasoning do not fuel this line of thinking, state no to the question as being ambiguous may prompt further questioning and does not allow the student to be appropriately tested. The aim of the exercise is to take a focused history; short answers are required.
You are a 21 year old student, you live with 3 other housemates.
Key details: you are anxious, keep playing with your fingers, have sweaty hands.
- You used to go to University until a couple of months ago
- When you used to go you found your heart racing fast, felt dizzy and your hands would be really sweaty. When this happens you have to leave and go home.
- Over time you have started to feel like this whenever you leave the house. You are able to leave the house with friends but you constantly feel sick and want to go home.
- You try to avoid going out and have started ordering your food online to avoid going into crowded places such as the supermarket. You avoid leaving the house by telling people you aren’t feeling well or you have lots of uni work to catch up on.
- You have upcoming exams and you are worried you will not be able to go and as a result will fail the year and be kicked out of uni
- These symptoms have been getting worse over the past 2 months
- You struggle to get to sleep and only sleep for about 3-4 hours a night, sometimes you have a sleeping tablet to help this but do not want to become hooked on this
- You feel down about all of this because you used to be a social person and this is not like the old you at all. Concentration, mood and energy is fine if you are at home. You are still able to be social inside the house
- No ongoing medical problems
- No mental health problems previously
- Not on any regular medications
- You have started smoking recently as this helps. Smoke about 25 cigarettes per day
- You have started drinking more alcohol as you find after a few drinks the anxiety feeling starts to melt away. About a bottle of wine in the evenings. You have no signs or symptoms of alcohol dependency if asked (not concerned about drinking, no craving, no early morning shakes)
- Dad sometimes says he has migraines when out in public and has to leave suddenly, you have never asked him about this but you think he has anxiety
- You are not sure what is going on, you are willing to try what the doctor thinks is best